Clark County and Ohio leaders want to educate residents and doctors about the dangers of prescribing opioids, which could lead to illicit drug use and fatal overdoses.

About 80 percent of people who died from drug overdoses were prescribed opioids at some point, according to data from the Ohio Automated Rx Reporting System database, said Lance Himes, the director of the Ohio Department of Health. More than 4,000 people in Ohio died of drug overdoses in 2016.

“We know that people are having prescriptions before they’re dying of an overdose,” he said.

However Clark County leaders say the majority of people who died of overdoses here in the past three years didn’t indicate prescription drug usage, according to a countywide committee that reviews local drug deaths.

“It doesn’t seem to be what we’re coming up against,” Clark County Health Commissioner Charles Patterson said. “There are definitely individuals who have been affected by that and it started with a surgery and opiate use after that.”

The Ohio Department of Health recently began the Take Charge Ohio campaign, a $1 million initiative designed to curb the amount of opiates prescribed by doctors throughout the state.

About 5.2 billion opioid doses were dispensed in Ohio between 2010 and 2016, including more than 77.7 million in Clark County and 19.9 million in Champaign County, according to OARRS data. More than 10.5 million opioids were prescribed in Clark County in 2016.

The number has decreased each year since 2012, when 792 million were dispensed in Ohio. In 2016, about 635 million opioids were dispensed to Ohio patients, a drop of nearly 157 million pain pills in a four-year span.

“We’re very hopeful our measures and interventions are working,” Himes said. “However, with the increase in the appearance of fentanyl and carfentanil and those opioid analogs, they’re involved in most of the overdoses we’re seeing.”

New rules for prescribing opiates enacted last August will also make some pain medications less available for people, leaders said. No numbers are available, but Himes said the state has already seen a big reduction in the numbers of prescriptions.

“We’re hopeful again that translates into less addiction and less people converting from prescription opioids to the illicit drugs,” Himes said. “It’s a challenge, but we’re all hands on deck.”

$1 million campaign

A $1 million marketing campaign, Take Charge Ohio, was recently launched in November to give doctors and other prescribers tools to talk with patients about the risk of prescription pain killers. A grant from the Centers for Disease Control and Prevention was used to launch the campaign.

Another piece of the program, Start Talking, is designed to teach Ohio parents to talk to their children about the dangers of prescription drugs, Himes said. They’re also encouraging schools and faith-based organizations to talk more with young people about drugs.

“We’re trying to make sure the message gets out there,” Himes said.

Local response

The county has seen a steady decline in opioid prescriptions since 2010. About 83.5 doses of opioids per capita were prescribed here in 2010, which fell to 76.3 doses per capita in 2016. However, that number was still higher than the state average of about 55.1 opioid doses per capita.

The Clark County Combined Health District recently applied for a $100,000 state grant for multiple programs targeting the opioid epidemic, Patterson said, including money to host a forum with doctors about best practices for prescribing pain medications and how it relates to addiction.

Prescribing habits have changed dramatically over the past 10 years but it’s still a work in progress, said Eric Juergens, a Springfield pharmacist and owner of Madison Avenue Pharmacy.

“They’re more under control than they were previously,” he said.

Some of the demographics, such as the aging population or laborers with work-related injuries, may also play a role in the county’s opioid data, Juergens said.

“I wouldn’t expect our numbers to equal the same as somewhere with a lot of white collar jobs,” Juergens said. “People sitting in office chairs don’t get hurt. People working in factories, print shops, mills, they get hurt more often. It’s the nature of our jobs (here).”

McKinley Hall drug treatment center in Springfield continues to hear about patients who have traded medications for other drugs, even if it’s a week supply, CEO Wendy Doolittle said.

“You’ll hear people talk about selling their prescriptions for cash to get whatever they need to get high,” she said. “I don’t know how we catch all of them. I’m a huge proponent of reducing the demand because I feel like the supply is always going to be there.”

The health community must get on the same page when it comes to prescribing narcotics, Doolittle said, and alternative medications must be in place for helping people with illnesses or injuries such as a strained back.

“We’re just not there yet,” Doolittle said.

Solutions

Mercy Health has worked to keep people from abusing prescription drugs through its drop box program at its hospitals, said Dr. Larry Graham, president of behavioral health services for the health system, which operates Springfield Regional Medical Center and Mercy Health-Urbana Hospital. The program allows patients to drop off old prescriptions to be disposed of properly, rather than keeping them in their medicine cabinets at home.

They’ve also begun screening patients who might be at-risk for alcohol, drugs and depression through its Screening, Brief Intervention, and Referral to Treatment process. If a person tests positive, they’re then referred for treatment. Mercy Health has completed more than 65,000 screenings throughout its extensive health system, Graham said.

Springfield hospitals and doctor’s offices set internal guidelines in 2016 for prescribing opioids to patients with acute pain, Graham said, such as no longer prescribing narcotics to patients with acute pain in the emergency department at the Springfield Regional Medical Center.

“People come in with whatever their story is and a lot of times it’s manipulation, we all know that,” Graham said.

One of the largest complaints at the ER is tooth pain, Graham said. In the past, people could walk out with opiates to relieve the pain, he said.

Now in Springfield, rules have been posted to educate people about what medications will be used to treat certain pain. It’s allowed the hospital staff to do less detective work about the types of pain patients have, he said.

“We’ve already seen a dramatic reduction in the amount of opiates we’re prescribing,” Graham said. “People know about what we’re doing and they’re not coming in to access those kind of prescription. In a good way, it’s reduced the opiate burden in Springfield.”

The program was piloted in Springfield and will likely be put in place at other Mercy Health facilities, Graham said.

Several large primary care practices have built alerts into their electronic medical records to flag people who have a history with narcotics, he said.

“There’s certainly some more work that can be done in that vein, but a lot of work has already been done by the larger groups and physician’s offices,” Patterson said.

As the state clamped down on prescription drug usage and pill mills earlier this decade, Patterson said it led to an uptick in illegal drug use, such as fentanyl. People now turn directly to the hard stuff, Doolittle said.

“They’ve worked very hard to control the problem,” Patterson said. “Unfortunately, there were some unforeseen things that have occurred because of some of the control measures.”

State Law

A new state law put into effect last August limits the number of narcotics doctors can prescribe at one time for patients with acute pain.

The law will allow for seven days of narcotics for adults and five days for children when the drugs are prescribed for acute pain. It also limits the total morphine-equivalent dose that is doled out and prescribers will be required to report diagnoses.

The most significant indicator of prescription drug abuse is the amount of pills patients were given their first prescription, Graham said.

“It was very intentional to say let’s limit the access of the first prescription,” he said.

Prescribers must also check OARRS before prescribing an opioid for more than a week. OARRS keeps track of prescriptions issued statewide and can allow prescribers to detect “doctor shopping” by addicts seeking more medications and allow prescribers to better track what medications a patient is taking.

The law also could reduce the amount of pills that can be consumed by other people or sold on the street, Juergens said. The law provides an evaluative period for people who might not need the medication after a week, Juergens said.

“We can give them something that’s not as strong,” he said.

This year, Mercy Health will begin tracking which physicians are prescribing narcotics at greater than 30 morphine-equivalent doses, the goal for physicians set by the state, Graham said. It allows the hospital to identify outliers and have a discussion with them, he said.

“Sometimes, there’s a reason they’re an outlier,” Graham said. “If you’re an oncologist and you’re seeing a lot of cancer patients, your prescription practices are going to be a lot different than if you’re a family practice. We know there are going to be reasons for those.”

In the past, the health care industry pushed to make sure patients had zero pain, Graham said. Today, that’s not a realistic goal, he said.

“For our physicians, we know there will be variations in there prescribing practices, but we want them to be aware of not only their own prescription practices, but how they align and compare to their peers,” Graham said.